Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease.

Background: Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors. Objectives: To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term. Design: Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis. At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined. At two-year follow-up, a new cardiological evaluation was performed. Statistical analysis: Quantitative data are presented as median and interquartile range (IQR). Mann-Whitney U test and Chi-squared were used for the between-group comparison. Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF). Results: We included 56 patients, with a median age of 12.5 years. In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF. At 24-month follow-up, the median LVEF was 70.5% (IQR 65.1%, 77%), while the delta-LVEF values was 3% (IQR -6.5%, 7%). Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025). In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF. Conclusions: Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.

Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter.

BACKGROUND: Central venous catheter (CVC) installation is essential for the treatment of critically ill neonates; however, it is associated with the development of neonatal intracardiac thrombosis, which is a complication that is associated with a poor prognosis. We aimed to identify specific risk factors for the development of intracardiac thrombosis in the right atrium (RA) and superior vena cava (SVC) related to the use of CVC in critically ill neonates. METHODS: A case-control study was conducted at the tertiary referral neonatal intensive care unit of the Pediatric Hospital Siglo XXI in Mexico City, Mexico from 2008 to 2013. The included cases (n = 43) were de novo patients with intracardiac thrombosis in the RA and SVC diagnosed by echocardiography. The controls (n = 43) were neonates without intracardiac thrombosis or thrombosis at other sites. A logistic regression analysis was conducted, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The independent risk factors for intracardiac thrombosis in the RA and SVC were the surgical cut-down insertion technique (OR = 2.98; 95% CI: 1.18-9.10), a maternal history of gestational diabetes/diabetes mellitus (OR = 10.64; 95% CI: 1.13-121.41), Staphylococcus epidermidis infection (OR = 7.09; 95% CI: 1.09-45.92), and CVC placement in the SVC (OR = 5.77; 95% CI: 1.10-30.18). CONCLUSION: This study allowed us to identify several contributing factors to the development of intracardiac thrombosis in the RA and SVC related to the installation of a CVC in a subgroup of critically ill neonates. Multicenter and well-designed studies with a larger number of patients could help validate our findings and/or identify other risk factors that were not identified in the present study.

Estudio de la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder en niños / Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children

Objetivo: La reducción en la perfusión pulmonar se ha descrito tras el cierre percutáneo del conducto arterioso permeable con varios dispositivos. Evaluamos la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso con el dispositivo Amplatzer Duct Occluder utilizando la gammagrafía pulmonar de perfusión. Métodos: Treinta pacientes con oclusión transcatéter exitosa del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder fueron incluidos en este estudio. La gammagrafía pulmonar de perfusión se realizó 6 meses después del procedimiento. Las velocidades de flujo máximo y la protrusión del dispositivo fueron analizadas por ecocardiografía Doppler. Una perfusión pulmonar izquierda < 40% se consideró anormal. Resultados: El implante del dispositivo fue exitoso en todos. La media de perfusión hacia el pulmón izquierdo fue de 44.7 ± 4.9% (37.8-61.4). Cinco pacientes (16.6%) mostraron disminución en la perfusión pulmonar izquierda. Tanto la edad y el peso bajo, así como la longitud del conducto arterioso y la relación diámetro mínimo y máximo con la longitud del conducto arterioso fueron estadísticamente significativos en los pacientes con anomalías de la perfusión pulmonar. Se observó protrusión del dispositivo en 6 pacientes con una velocidad de flujo máximo mayor en la arteria pulmonar izquierda. Conclusión: La perfusión pulmonar izquierda puede comprometerse tras el cierre percutáneo del conducto arterioso con el Amplatzer Duct Occluder. El aumento en la velocidad de flujo en el origen de la arteria pulmonar izquierda puede ser un pobre indicador de la reducción en la perfusión pulmonar y puede ocurrir en ausencia de protrusión del dispositivo.

Objective: The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. Methods: Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion < 40% was considered abnormal. Results: The device implantation was successful in all patients. Average perfusion of left lung was 44.7 ± 4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. Conclusion: The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.

[Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children]. / Estudio de la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder en niños.

OBJECTIVE: The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. METHODS: Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion<40% was considered abnormal. RESULTS: The device implantation was successful in all patients. Average perfusion of left lung was 44.7±4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. CONCLUSION: The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.

Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder in infants under 1 year of age.

INTRODUCTION AND OBJECTIVES: Percutaneous closure of patent ductus arteriosus (PDA) is a well-established technique. We evaluated the usefulness of the Amplatzer duct occluder for the percutaneous closure of patent ductus arteriosus in 29 children under 1 year of age. METHODS: The patients' mean age was 8.9+/-2.8 months and their mean weight was 6.4+/-1.5 kg. In addition, 24.1% of patients were aged 6 months or less and 17.2% weighed 5 kg or less. All completed follow-up (0.5-36 months). RESULTS: The minimum PDA diameter was 3.16+/-1.24 mm. The device was implanted successfully in 26 patients (89.6%). Failures were due to either the device migrating to the descending aorta, persistent moderate leakage, or to difficulty in the advancement of the device. No deaths were associated with the procedure. Three major complications occurred in two patients (10.3%). Aortography showed initial total occlusion in 65.5% of patients. At 3-month follow-up, total occlusion was observed in 96.1% of patients. Ultimately, closure was achieved successfully in 25 of the 29 patients (86.2%). During follow-up, four patients exhibited mild left pulmonary artery stenosis and one exhibited mild stenosis of the descending aorta. CONCLUSIONS: In children under 1 year of age, percutaneous closure of patent ductus arteriosus using an Amplatzer occluder was a safe and effective procedure. It is possible that improvements in the design of the occluder could decrease the complication rate.

Cierre transcatéter del conducto arterioso persistente con dispositivo de Amplatzer en niños menores de un año / Transcatheter closure of patent ductus arteriosus using the amplatzer duct occluder in infants under one year of age

Introducción y objetivos. El cierre percutáneo del conducto arterioso persistente (CAP) es una técnica bien establecida. Evaluamos la utilidad del oclusor de Amplatzer (ADO), en el cierre percutáneo del CAP en 29 niños menores de 1 año. Métodos. La edad de los pacientes fue de 8,9 ± 2,8 meses y el peso, 6,4 ± 1,5 kg. El 24,1% de los pacientes con edad ≤ 6 meses y el 17,2%, con peso ≤ 5 kg. Se realizó seguimiento en todos (0,5-36 meses). Resultados. El diámetro mínimo del conducto fue 3,16 ± 1,24 mm. El dispositivo se implantó con éxito en 26 (89,6%) pacientes. Las causas del fracaso se debieron a migración del dispositivo a la aorta descendente, persistencia de la fuga en forma moderada y dificultad en progresar el dispositivo. La mortalidad fue nula con el procedimiento. Ocurrieron 3 complicaciones mayores en 2 (10,3%) pacientes. Un aortograma mostró oclusión completa inicial en el 65,5% de los pacientes. La oclusión completa del conducto se demostró en el 96,1% de los pacientes al tercer mes de seguimiento. El éxito final del cierre del CAP se logró en 25/29 (86,2%) pacientes. En el seguimiento, 4 pacientes mostraron estenosis leve en la rama pulmonar izquierda, y 1, estenosis leve en la aorta descendente. Conclusiones. En niños menores de 1 año, el cierre percutáneo del CAP con el oclusor de Amplatzer es un procedimiento efectivo y seguro. Las mejoras en el diseño del oclusor posiblemente disminuirán la frecuencia de complicaciones (AU)

Introduction and objectives. Percutaneous closure of patent ductus arteriosus (PDA) is a well-established technique. We evaluated the usefulness of the Amplatzer duct occluder for the percutaneous closure of patent ductus arteriosus in 29 children under 1 year of age. Methods. The patients’ mean age was 8.9 [2.8] months and their mean weight was 6.4 [1.5] kg. In addition, 24.1% of patients were aged 6 months or less and 17.2% weighed 5 kg or less. All completed follow-up (0.5-36 months). Results. The minimum PDA diameter was 3.16[1.24] mm. The device was implanted successfully in 26 patients (89.6%). Failures were due to either the device migrating to the descending aorta, persistent moderate leakage, or to difficulty in the advancement of the device. No deaths were associated with the procedure. Three major complications occurred in two patients (10.3%). Aortography showed initial total occlusion in 65.5% of patients. At 3-month follow-up, total occlusion was observed in 96.1% of patients. Ultimately, closure was achieved successfully in 25 of the 29 patients (86.2%). During follow-up, 4 patients exhibited mild left pulmonary artery stenosis and 1 exhibited mild stenosis of the descending aorta. Conclusions. In children under 1 year of age, percutaneous closure of patent ductus arteriosus using an Amplatzer occluder was a safe and effective procedure. It is possible that improvements in the design of the occluder could decrease the complication rate (AU)

[Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results]. / Angioplastía con balón de la coartación aórtica nativa en niños menores de 12 meses: resultado inicial y a mediano plazo.

INTRODUCTION AND OBJECTIVES: The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome. MATERIAL AND METHOD: We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16). RESULTS: Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group). CONCLUSIONS: Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to improve the final outcome and decrease the incidence of complications. A second balloon angioplasty procedure might improve the final outcome.

Angioplastía con balón de la coartación aórtica nativa en niños menores de 12 meses: resultado inicial y a mediano plazo / Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results

INTRODUCTION AND OBJECTIVES: The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome. MATERIAL AND METHOD: We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16). RESULTS: Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group). Conclusions: Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to...

Cierre transcatéter del conducto arterioso permeable con coils de liberación controlada: Resultados inmediatos y seguimiento a mediano plazo / Transcatheter occlusion of the patent ductus arteriosus with detachable coils: immediate results and intermediate-term follow-up

Objetivo: Determinar la frecuencia de éxito y seguridad del cierre percutáneo del conducto arterioso permeable (CAP) con coils de liberación controlada. Método: Cuarenta y un pacientes pediátricos con conducto arterioso permeable (CAP), de un tamaño pequeño a moderado (diámetro mínimo < 4 mm), fueron sometidos a cierre percutáneo con coils de liberación controlada. Los resultados se establecieron mediante estudios angiográficos y ecocardiográficos. La media de edad fue de 2.0 ±1.3 años (rango, 0.6-5.6 años); la media de peso fue de 10.0 ± 3.4 kg (rango, 4.5-18.0 kg). La media del diámetro mínimo del CAP fue de 1.69 ± 0.6 mm (rango, 0.5-4 mm). Resultados: En 39/41 pacientes se logró la implantación del dispositivo (95%). La relación media del coil/CAP fue de 3.41 ±1.1. Inmediatamente posterior a la oclusión con el coil, 18 conductos arteriosos no mostraron flujo residual por angiografía; 18 tenían un cortocircuito residual trivial, 3 leve y 2 leve. No se presentaron complicaciones significativas con el procedimiento. En las primeras 24 horas posteriores a la implantación del coil, el control ecocardiográfico mostró oclusión completa en 35 pacientes. En los 4 pacientes con flujo residual, el seguimiento ecocardiográfico demostró ausencia del cortocircuito 3 meses después en 2 pacientes y 6 meses después en un paciente. En uno, no se ha logrado la oclusión completa a un año. En dos pacientes (5%) se abandonó el procedimiento: en un paciente, por mostrar flujo residual moderado y movimiento del extremo pulmonar del coil, que debió de ser retirado con un catéter lazo y en otro, por migración del coil. Ambos pacientes fueron enviados a cirugía. En un seguimiento medio de 29.5 ± 16.5 meses (rango, 0 a 60 meses) de los 39 pacientes, no se observó flujo residual por ecocardiografía Doppler color, excepto en uno. Conclusión: Nuestros resultados, en concordancia con otros autores, sugieren que la oclusión del conducto arterioso permeable con coils de liberación controlada, es un método seguro, efectivo y de bajo costo. La oclusión con coil deberá ser el procedimiento de elección en pacientes mayores de 6 meses de edad con conductos arteriosos permeables de un tamaño pequeño a moderado (< 4 mm). En la extensión de este procedimiento a recién nacidos y a pacientes con conductos arteriosos más grandes, deberá considerarse otro tipo de dispositivo oclusor.

Objective: To determine the success rate and safety of percutaneous closure of patent ductus arteriosus (PDA) with a detachable coil. Methods: Forty-one children with small-to moderate-size PDA (maximum diameter < 4 mm) underwent percutaneous coil occlusion. The results were assessed by angiography and echocardiography The mean age was 2.0 ± 1.3 years (range 0.6 to 5.6 years); mean weight was 10.0 ± 3.4 kg (range 4.5 to 18.0 kg). The mean minimum diameter of the PDA was 1.7 ± 0.6 mm (range, 0.5 to 4.0 mm). Results: The occlusion device was inserted in 39 of 41 patients (95%). The mean coil/PDA ratio was 3.41 ±1.1. We observed angiographic cessation of blood flow through the PDA after coil insertion in 18 patients; 18 patients had residual shunt, 3 mild shunt and 2 moderate shunt. No complications were observed during the procedure. Thirty-five patients showed absence of blood flow through PDA 24 hours after coil occlusion by echocar-diography The other four patients with residual shunt showed flow cessation after 2 months in two patients and after 6 months in the other two. Failure of coil insertion in two patients was due to detachment of the pulmonary edge of the coil, which was subsequently removed in one, and due to coil migration in the other, both patients underwent surgical PDA closure. Mean follow-up at 29.5 ± 16.5 months showed no residual blood flow through the occluded PDA, except for one patient. Conclusion: Our results, as many others, suggest that PDA coil occlusion is a safe, effective, and cheap procedure. PDA coil occlusion should be the elective method for PDA closure in patients older than 6 months of age with small-to moderate size PDA(< 4 mm). The procedure in newborn infants and patients with larger PDA must be made with a different type of occlusive device.

[Transcatheter occlusion of the patent ductus arteriosus with detachable coils: immediate results and intermediate-term follow-up]. / Cierre transcatéter del conducto arterioso permeable con coils de liberación controlada: resultados inmediatos y seguimiento a mediano plazo.

OBJECTIVE: To determine the success rate and safety of percutaneous closure of patent ductus arteriosus (PDA) with a detachable coil. METHODS: Forty-one children with small- to moderate-size PDA (maximum diameter < or = 4 mm) underwent percutaneous coil occlusion. The results were assessed by angiography and echocardiography. The mean age was 2.0 +/- 1.3 years (range 0.6 to 5.6 years); mean weight was 10.0 +/- 3.4 kg (range 4.5 to 18.0 kg). The mean minimum diameter of the PDA was 1.7 +/- 0.6 mm (range, 0.5 to 4.0 mm). RESULTS: The occlusion device was inserted in 39 of 41 patients (95%). The mean coil/PDA ratio was 3.41 +/- 1.1. We observed angiographic cessation of blood flow through the PDA after coil insertion in 18 patients; 18 patients had residual shunt, 3 mild shunt and 2 moderate shunt. No complications were observed during the procedure. Thirty-five patients showed absence of blood flow through PDA 24 hours after coil occlusion by echocardiography. The other four patients with residual shunt showed flow cessation after 2 months in two patients and after 6 months in the other two. Failure of coil insertion in two patients was due to detachment of the pulmonary edge of the coil, which was subsequently removed in one, and due to coil migration in the other, both patients underwent surgical PDA closure. Mean follow-up at 29.5 +/- 16.5 months showed no residual blood flow through the occluded PDA, except for one patient. CONCLUSION: Our results, as many others, suggest that PDA coil occlusion is a safe, effective, and cheap procedure. PDA coil occlusion should be the elective method for PDA closure in patients older than 6 months of age with small- to moderate size PDA (< or = 4 mm). The procedure in newborn infants and patients with larger PDA must be made with a different type of occlusive device.